Author + information
- Muhammad Khalid,
- Puja Sitwala,
- Vatsal Ladia,
- Kamesh Sivagnanam,
- Timir Paul and
- Kais Albalbissi
The rarest variety of coronary anomaly is a single coronary artery with a prevalence rate of 0.02 to 0.06%. Most of the these patients are diagnosed incidentally or present with syncope, chest pain or sudden cardiac death.
A 68 year-old female with history of hypertension and diabetes mellitus is admitted with crescendo angina. A coronary angiography revealed a single ostium in the right sinus of valsalva (RSV) giving rise to a common coronary trunk (CCK) which bifurcated into the right coronary artery and left main coronary artery (LMCA) (Figure 1A). Computerized tomographic angiography confirmed a short common trunk arising from the RSV (Figure 1B-C). The LMCA had an anomalous origin from the CCT, ran a prepulmonic benign course up to the anterior interventricular groove where it divided into the left anterior descending artery and left circumflex artery.
The clinical outcome of these patients depends upon the course of artery, which could be interarterial, intramural, retroaortic, prepulmonic or subpulmonic. Interarterial course has the worst prognosis due to compression or kinking of artery between aorta and pulmonary artery. Due to the benign course of anomalous LMCA this patient remained asymptomatic for a long time and presented with severe coronary artery disease.
It is important to rule out coronary anomalies in young patients with angina or exertional syncope, as is the second most common cause of sudden cardiac death in this population.
Poster Hall, Hall A/B
Sunday, March 11, 2018, 3:45 p.m.-4:30 p.m.
Session Title: FIT Clinical Decision Making: Pulmonary Hypertension, VTE, Congenital Heart Disease and Prevention
Abstract Category: Congenital Heart Disease
Presentation Number: 1241-172
- 2018 American College of Cardiology Foundation